How engagement with religious groups can help fight COVID-19

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A sehat aapa leads a parenting program. Photo by: Aga Khan Foundation

NEW DELHI — Mehrunisha Khan lives in New Delhi’s Nizamuddin Basti, a densely populated neighborhood recently in the spotlight. In March, a religious gathering of over 1,000 members of the Tablighi Jamaat, a little-known Islamic sect, was named a “superspreader” event after many participants who returned to different Indian cities tested positive for the coronavirus. This fueled discrimination against Muslims living in the Nizamuddin area, as well as fear and anger within the community.

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It was in this tense atmosphere that Khan conducted a household survey to help the Delhi government in contact tracing, accompanied by the police and public health officials. She is a “sehat aapa” — a Hindi term meaning “health sister” — and has been working with the community for over eight years.

“In three days, we went to over 1,800 houses. Since we know the community well, I was able to go in and ask questions such as: ‘Do you have symptoms?’ ‘Have you traveled anywhere recently?’” Khan told Devex.

There are 50 such community health workers in the neighborhood. They are trained by the Aga Khan Trust for Culture, or AKTC, and they act as a bridge between the local government’s health department and the community.

Trust is a key piece of the COVID-19 response. In places experiencing religious discrimination, community-based health workers are often the most effective messengers. Sometimes, religious leaders are the ones who carry the credibility to help individuals adopt healthier behaviors. But while nonprofit organizations and United Nations agencies rely on such influencers within communities, these groups are also cautious about overstepping into religious life.

Long-term engagement

While organizations such as AKTC are using trusted health workers to reach communities, the United Nations Children’s Fund is working with religious leaders across South Asia through its Regional Multi-Religious and Faith Leaders[a] initiative.

Well before the coronavirus became a public health crisis, UNICEF had been working with faith leaders in Pakistan on public health communication campaigns, including around polio vaccine safety. With rising numbers of COVID-19 cases in the country, UNICEF worked with the government to design and implement a communications strategy for this new health threat.

Sehat aapas help conduct house-to-house surveys to identify symptomatic COVID-19 cases in Nizamuddin, New Delhi, India. Photo by: Aga Khan Foundation

“Pakistan is more than 95% Muslim. In that case, the religious leaders become our key influencers,” Zohra Nisar Hunzai, a communication-for-development officer at UNICEF Pakistan, told Devex.

To date, UNICEF has brought on board more than 80,000 imams across Pakistan’s four provinces, Hunzai said.

In April, the organization sent a "social mobilizer" in a van from mosque to mosque to train religious leaders and help them deliver public health and safety messages to their communities. However, due to the barriers to in-person communication, UNICEF had to adapt its traditional approach.

“As C4D [communication for development] people, it’s very important for us to have face-to-face interaction. But because we don’t want to put anyone at risk, we have largely focused on WhatsApp as our main communication channel,” Hunzai said.

In working with the faith leaders, UNICEF has made use of their position of trust and power in the community. “There is a huge belief in the religious leaders. There was no question in our mind that we had to work with them on COVID,” Hunzai said.

In places such as Delhi where the COVID-19 response was colored by discrimination against Muslims, finding influential community members became essential to reinforce trust. But this is not done overnight. AKTC worked with women who are vocal and influential in neighborhoods, and making them a trustworthy voice has been a work-in-progress over seven years.

The community health program started with support from Tata Trusts in 2012, and 50 women were selected and trained. “We knew they would have to talk to the community about sensitive topics such as reproductive health, so we selected women who could mobilize others,” AKTC CEO Ratish Nanda told Devex.

The initiative was part of AKTC’s Historic Cities Programme, which is working on the conservation of historical landmarks such as Humayun’s Tomb and Sunder Nursery — where Nizamuddin Basti is located. “There is no point of conservation without improving the lives of people living around it. That is why we wanted to prioritize health,” Nanda said.

As part of their daily work, Khan and other sehat aapas keep detailed information about every family’s health and accompany women for deliveries and immunizations. Each sehat aapa is responsible for 200 houses.

They have also used WhatsApp to combat disinformation by sending voice messages to families. “We have to think of new ways to make sure people follow guidelines,” Khan said, acknowledging that getting people to follow social-distancing norms has been challenging, especially since over half of local families live in one-room makeshift homes.

The women’s long-term connection with families helped limit the spread of the coronavirus, Nanda said.

“If the sehat aapas hadn’t done the house-to-house surveys, we know the police would have been highhanded, and that would have further aggravated the community,” he said.

A limited role to play?

UNICEF’s relationship with religious leaders was put to the test during the holy month of Ramadan.

Even though a strict lockdown was imposed in Pakistan, the government was under pressure to reopen mosques during Ramadan. UNICEF faced the dilemma of how involved it should get in deliberations between the government and religious groups.

“We were very cautious to ensure that there are no negative repercussions. People can say, ‘This is a Western agenda and they don’t want us to pray,’” Hunzai said.

“There is a huge belief in the religious leaders. There was no question in our mind that we had to work with them on COVID.”

— Zohra Nisar Hunzai, communication-for-development officer, UNICEF Pakistan

“When it comes to religious rituals, we believe it’s not really for the international agencies such as ours to get involved. There’s an issue of cultural sensitivity and also credibility. When messages come from the religious leaders, people are more likely to listen to them,” she said.

Finally, a 20-point agenda was agreed upon that laid out guidelines for opening mosques, with UNICEF providing technical assistance in the agenda’s creation. Hunzai said she is not sure whether it was implemented properly. “People were still going to the mosque in large groups. They were still not wearing masks. Some were saying, ‘Allah will save us.’”

Among organizations that work with religious groups, there is an awareness that religious prejudice and discrimination are harder to fight than even health and other development issues, especially when working with minority groups.

As rumors spread that Muslims from the Tablighi Jamaat had been responsible for spreading COVID-19 across the country, people living in Nizamuddin felt its impact. Some women were fired from their jobs as domestic workers, and hospitals refused to admit patients from the neighborhood, Khan said.

“Even after coronavirus goes away, we will have to live with the fear of discrimination,” she said.

“We have strived for 12 years to remove the ghetto image from Nizamuddin. This blatant communalism has set us back again. It calls for an intervention and more collaboration and partnerships,” Nanda said.

Devex, with support from our partner GHR Foundation, is exploring the intersection between faith and development. Visit the Focus on: Faith and Development page for more. Disclaimer: The views in this article do not necessarily represent the views of GHR Foundation.

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About the author

  • Amruta Byatnal

    Amruta Byatnal is an Associate Editor at Devex. She reports on global health and human rights, with a special focus on the politics of international food policy. Previously, she worked for News Deeply and The Hindu. She is a graduate of Cornell University where she studied international development.